Hallux valgus

Hallux Valgus, commonly referred to as a bunion, is a complex valgus deformity of the first ray that can cause medial big toe pain and difficulty with shoe wear.

Diagnosis is made clinically with presence of a hallux that rests in a valgus and pronated position. Radiographs of the foot are obtained to identify the severity of the disease and for surgical planning.

Treatment can be nonoperative with shoe modifications for mild and minimally symptomatic cases. Surgical management is indicated for progressive deformity and difficulty with shoe wear.

Who to refer, who not to refer, how to refer

Who to Refer

Those who have failed Primary care management

Urgent Referral Criteria

Ulcers despite Podiatry input

Who Not to Refer

Those who have not tried Primary care management

Additional Info

99% of these will go to Orthopaedic Podiatry – refer to them unless they have had input from them already
Unlikely to operate BMI >40

Imaging

Xray WB Foot (Ideally xray is < 1yr old)

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border.

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)

Primary care management

Podiatry Input
Bought shoes that fit from Hotter / Cosy Feet
Regular maximum multimodal analgesia
Education
BMI >35 engage in wellbeing support

Resources and links

Primary Care Foot Pathway - developed by First Contact Practitioners / Podiatry (To be confirmed, will update when available)

Local service details

orthopaedics@borders.scot.nhs.uk

bor.orthoreferrals@borders.scot.nhs.uk

Last reviewed: 31/07/2025

Next review date: 31/07/2027

Author(s): Mr Roshan Raghavan.

Author email(s): Roshan.Raghavan@nhs.scot.